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HomeMy WebLinkAboutBLDCI-16-006479-05 `/ %*,\ ci://' The Commonwealth of Massachusetts = City\Town of i =e`ie�7 YARMOUTH "! New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:WEST YARMOUTH CONGREGATIONAL CHURCH BLDCI-16-006479-05 Trade Name:WEST YARMOUTH CONGREGATIONAL CHURCH property Certificate Expiration Identifyroe address including street number,name,city or town and county Located at r 383 ROUTE 28 05/01/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy - Use Group Other Classifications(s) 210 PERSONS A-3 01st Floor 210 A-3 Amusement/Church/Gym/Library/Museum Other 40 A-3 Amusement/Church/Gym/Library/Museum BALCONY Allowable Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Grylls Date of ��l—�t Building Commissioner Inspection Signature of Municipal Date of Signature of Municipal Issuance 0672,1Building Commissioner F50.00 BLD Certoflnspection.rpt TOWN OF YARMOUTH 67.*V475) BUILDING DEPARTMENT vy'�•s� • ,,t: ,,. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION DATE: 03/17/2021 PAYABLE UPON RECEIPT ( X) Fee Required $50.00 G CO. ' g ( ) No Fee Required B ►tip- I a In accordance with the pro4isions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 37.3 Z�-C as; ct.)�¢r--y n ae.4-4� y i t4 0.2413 ClwvrCll Q�Q' Name of Premises: (,J.yet v rye 'u- �r 4 re. a,}iv h 62.,1 Tel: '7Z5' P Purpose for which permit is used: (inch 73v; Id; s License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency cv- k.3yCC— Certificate to be issued to h ,}i C�,Q��,(o�,�..� Tel: 5r')fj-77Z- gag ?e// o r' Aved Address: 371 -{„r o?4'� t 'J . � -�,�c , y4A A.247'? 50g 775-or Owner of Record of Building j. �Ay.pet dr urCl, Address 37r- "J k p` LA), y car,,.i Y'tk Ua(,'7- Present Holder of Certificate (J YCC Y31C)Or okse ?eourrnb Si ature of person to whom Title ertificate is issued or his agent (3. A - & Date Email Address: �Qh� Tav►�,���.Ce�rn Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten (10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 56,6 C/--/(o-.00� ,79 ��- 05/01/2021- - 05/01/2022 THE HARTFORD BUSINESS SERVICE CENTER THE ' ' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 March 26, 2021 West Yarmouth Congregational Church 383 ROUTE 28 WEST YARMOUTH MA 02673 Account Information: Contact Us PolicyHolder Details : WEST YARMOUTH CONGREGATIONAL CHURCH Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (866) 467-8730 Fax: (888) 443-6112 Email: agency.services(c�thehartford.com Website: https://business.thehartford.com Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR005 d ACT( Jr DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR i'RODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subjact to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: FITTS INSURANCE AGENCY INC 08088026 PHONE (508)620-6200 FAX (508)481-0227 (A/C,No,Ext): (A/C,No): 2 WILLOW STREET SUITE 102 E-MAIL ADDRESS: SOUTHBOROUGH MA 01745 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Twin City Fire Insurance Company 29459 INSURED INSURER B: WEST YARMOUTH CONGREGATIONAL CHURCH INSURER C• 383 ROUTE 28 WEST YARMOUTH MA 02673-4721 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD/YYYYI (MM/DD/Y YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL 8 ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE POLICY PRO LOC PRODUCTS-COMP/OP AGG JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) _ AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $1.000,000 A .PROPRIETOR/PARTNER/EXECUTIVE N/A 08 WEC NN5968 10/01/2020 10/01/2021 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION West Yarmouth Congregational Church SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 383 ROUTE 28 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED WEST YARMOUTH MA 02673 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE °II' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 March 26, 2021 West Yarmouth Congregational Church 383 ROUTE 28 WEST YARMOUTH MA 02673 Account Information: Contact Us PolicyHolder Details : WEST YARMOUTH CONGREGATIONAL CHURCH Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (866) 467-8730 Fax: (888) 443-6112 Email: agency.servicesthehartford.com Website: https://business.thehartford.com Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR005